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Do I have to pay my deductible before the insurance company pays anything? Consumer Q&A

By on February 8th, 2013
Filed: Advice, Consumers, Health Insurance, You

Paying a deductible can feel like a burden, and deductibles have gone up quite a bit in the past several years.

According to eHealth’s 2012 Cost and Benefits report, the average deductible for individually-purchased health insurance plans has increased a whopping 79% between 2005 and 2012. The average deductible for individual coverage in 2012 was over $3,000.

Last week on Yahoo Answers we took a question from someone with a $5,000 deductible. She was worried that some blood work she’d recently had wouldn’t be covered by the insurance company because she hadn’t paid out her deductible yet.

She also asked: If you have a really high deductible, is there any value in health insurance at all?

The eHealthInsurance reply was voted Best Answer:

Some preventive health screenings are now available at no out-of-pocket cost to you, due to health reform. It’s not clear, however, if the blood work you had will qualify. You’ll have to wait and see how the claim is processed by your insurance company.

If it’s not a covered preventive screening, then yes, you’ll probably have to pay your deductible first before the insurance company starts picking up the bill.

You will benefit, however, from the discounted rates that your insurance company has negotiated with its in-network providers (assuming you saw an in-network provider). Harsh as it sounds, an uninsured person is typically required to pay more than an insured person for the same medical care.

Image by Flickr user DorkyMum


About Douglas Dalrymple


Doug Dalrymple is a member of the communications team at eHealth, Inc. and has worked in the health insurance and technology industries for fifteen years. He works on communications strategy, content creation and management, project management, and corporate messaging.

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